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Law of Projection Labeled line. Seizures and Epilepsies. Definition neurological deficits (positive or negative) caused by abnormal neuronal discharges in the hemisphere or brain stem seizure, epileptic seizure epilepsy (chronic, recurrent seizures) www.metaDON.NET. postictal period.

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slide1

Law of Projection

Labeled line

seizures and epilepsies
Seizures and Epilepsies

Definition

  • neurological deficits (positive or negative) caused by abnormal neuronal discharges in the hemisphere or brain stem
  • seizure, epileptic seizure
  • epilepsy (chronic, recurrent seizures)
  • www.metaDON.NET
slide4

postictal period

interictal period

ictus

ictus

  • ictus, ictal period
  • posticatal period
  • interictal period

interictal period

etiologies
Etiologies

Normal reaction to stress:

  • sleep deprivation
  • physical stress: fever, overwork, over exercise
  • chemical reaction: alcohol
  • psychological stress
etiologies1
Etiologies
  • Vascular: cerebrovascular disease
  • Infectious/inflammatory: encephalitis
  • Neoplastic: primary v.s. metastatic
  • Degenerative: Alzheimer
  • Intoxicative: alcohol
  • Congenital/hereditary: neurocutaneous ~
  • Autoimmune: multiple sclerosis, LE
etiologies2
Etiologies
  • Traumatic
  • Endocrinopathic: DM
  • Nutritional: pyridoxine deficiency
  • Hematologic: polycythemia, leukemia
  • Idiopathic
  • Metabolic: uremia, electrolyte imbalance
classification
Classification
  • Partial: epileptic activity confined to one hemisphere
  • Generalized: epileptic activity originated from both hemispheres
  • Unclassifiable
partial seizure
Partial seizure
  • Epileptic focus confined to unilateral hemisphere
  • Simple = normal consciousness (wakefulness and awareness)
  • Complex, involved frontal, temporal or limbic system = impaired awareness (normal wakefulness)
simple partial
Simple Partial ~
  • With motor signs: jerks of body parts
  • With somatosensory or special sense symptoms: touch, numbness, etc.
    • somatosensory, visual, auditory, olfactory, gustatory, vertiginous ~
  • With autonomic s/s:
    • palpitation, nausea, vomiting
  • With psychic s/s:
    • rage, aggression
complex partial
Complex Partial ~
  • Impaired awareness always
  • With automatism
  • Automatism = involuntary, automatic behaviors while having impaired consciousness
  • Spontaneous ~ v.s. reactive ~
generalized seizures
Generalized seizures
  • Epileptic foci confined to both hemispheres
  • Impaired consciousness is a must, except myoclonus
  • Postictal symptoms is a must, except absence and myoclonus
slide13
Absence
  • Myoclonic
  • Clonic
  • Tonic
  • Tonic-clonic
  • Atonic
diagnosis
Diagnosis
  • Clinical diagnosis
  • Definite diagnosis
clinical diagnosis
Clinical Diagnosis

Seizure history

  • aura: somatosensory, visual, olfactory
  • clinical seizure: details of description
  • postical period: confusion
  • precipitating factor: sleep deprivation, alcohol, fever, overwork, work stress, psychological stress
  • frequency: per month, per year
  • age of onset: childhood, adult, elderly
  • progression of symptoms: improved or worsened
  • AED: what, dose, side effects
clinical diagnosis1
Clinical Diagnosis
  • Past medical history
  • Family history
  • Psychosocial history
physical examination
Physical Examination
  • General examination
  • Neurological examination
observation of seizures
Observation of Seizures
  • When necessary, observation may be the only way to diagnosis.
lab examination
Lab Examination
  • Routine lab: relevant investigations
  • EEG: negative interictal EEG does not exclude seizure/epilepsy. Positive EEG is diagnostic only with related clinical S/S.
  • CT or other imaging: indicated only when focal pathology is suspected.
differential diagnosis
Differential Diagnosis
  • Syncope: generalized weakness of muscles with loss of muscle tone, inability to stand upright, and a loss of consciousness due to reduced of oxygenation by any cause.
  • Fainting (presyncope)
  • Hypoglycemia
differential diagnosis1
Differential Diagnosis
  • TIA (transient ischemic attack)
  • Migraine
  • NES
  • etc.
syncope
relation to posture

time of day

skin color

aura duration

convulsion

injury

incontinence

postictal confusion

postictal headache

focal neurological deficits

cardiovascular signs

abnormal EEG

Syncope
migraine
Migraine Seizure

Motor seizures no yes

Prodrome symptoms >5 min. < 1 min.

Loss of consciousness no yes

Epigastric sensation nausea pain

EEG slowing discharge

Migraine
hypoglycemia
Epinephrine release: sweating, tremor, tachycardia, anxiety, hunger

CNS symptoms: dizziness, headache, clouding of vision, blunted mental acuity, loss of fine motor skill, confusion, abnormal behavior, convulsion and loss of consciousness

Blood sugar (45 mg/dL)

Hypoglycemia
management
Management
  • Precipitating factors
    • sleep deprivation, alcohol, overwork, stress, fever
  • Pharmacological treatment
    • phenobarbital gr I: 1-3 tab oral OD, hs
    • phenytoin 100 mg: 1 cap tid pc
    • carbamazepine 200 mg: 1 tab tid pc
    • valproate 200 mg: 1 tab tid pc
drug treatment
Drug treatment
  • Duration of treatment = 3-4 years
  • Tapering off 1/3-1/4 q 3 months